Gastrocnemius recession: A treatment for foot pathology associated with isolated contracture.

摘要

Isolated gastrocnemius contracture (IGC) is characterized by limited ankle dorsiflexion with full knee extension. IGC has been associated with painful foot pathologies that, left untreated or treated unsuccessfully, can severely reduce function and affect quality of life. Acquired shortness of the gastrocnemius renders the muscle unable to stretch sufficiently to accommodate normal ankle and knee joint motion during gait. Consequently, patients may demonstrate alterations in gait patterns during stance which could include early heel rise, decreased ankle dorsiflexion, and/or increased knee flexion. These gait deviations could potentially precipitate lower extremity injury. Gastrocnemius recession is a procedure in which the gastrocnemius is divided distal to the musculotendon junction and may be a beneficial treatment option for patients failing conservative management. While surgical recession procedures increase dorsiflexion range of motion and function, there have been no quantitative biomechanical studies investigating gait mechanics and strength changes in this subject group.Therefore, the overall goal of this work was to assess function, plantar flexion strength, plantar pressure, and gait mechanics in a group of subjects clinically diagnosed with IGC pre- and post-surgical recession compared to healthy control subjects. Three studies were conducted to accomplish this overall goal. The first study assessed plantar flexion strength, function, and passive range of motion pre- and post-surgery compared to control subjects. The second study evaluated gait mechanics including time to heel rise and peak forefoot plantar pressure. The third study assessed ankle and knee kinematic and kinetic patterns. From these studies we learned that subjects with IGC are limited in passive dorsiflexion range of motion, function, and plantar flexion strength pre-operatively compared to control subjects. It appears function and strength increase following gastrocnemius recession surgery thus subjects with IGC are more similar to those without contracture. While subjects with IGC do demonstrate differences in stance phase kinematics and kinetics compared to control subjects, surgical recession did not induce further changes. This work establishes the first quantitative data to critically evaluate pre-surgery gait deviations in subjects with IGC, as well as the efficacy of surgical recession as a treatment option for those who fail conservative management.